癫痫患者的注意功能和注意网络的相关研究
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摘要
目的：通过对癫痫患者进行注意功能和注意网络的研究,探讨癫痫患者的注意功能和注意网络受损的特点,寻找反映癫痫患者注意功能损害的电生理指标,进一步分析注意功能和注意网络的相关性,为癫痫患者的认知功能特别是注意功能的深入研究打下基础。方法：选取已被诊断为癫痫的病人69例作为病例组,另外选取与癫痫患者年龄、性别、受教育年限相匹配且无神经精神疾病史及相关家族史的健康者35名,所有患者均行头颅CT或MRI检查。应用蒙特利尔认知评估量表(Montreal Cognitive Assessment, Moca Beijing version, MOCA)检测受试者的总体认知功能,分别用Stroop、持续操作任务实验(Continuous Performance Test,CPT)和双任务测试检测选择注意、持续注意和分散注意功能,收集Stroop实验中冲突、一致和中性条件下受试者的反应时和错误率,并计算出各自的干扰量；CPT测试的反应时、漏报率和虚报率；双任务实验的单任务及双任务的划销方格数目和字符串正确率,并计算出各自的双任务减退程度；同时进行注意网络测试(Attention Networks Test, ANT),收集ANT的反应时、正确及错误按键反应次数,计算每个测试对象的定向、警觉、执行控制网络效率、平均反应时间及正确率。结果：1.组间比较分析：(1)蒙特利尔认知评估结果：癫痫组较对照组的执行、注意和延迟回忆认知功能水平下降(P<0.05),抽象、定向、命名能力、语言功能水平无明显降低(P>0.05)。(2) Stroop实验评估选择注意：癫痫组与对照组相比,在冲突条件下反应时显著延长(P<0.01),在冲突、一致和中性条件下错误率显著增加(P<0.01),冲突和中性条件下反应时干扰量和错误率干扰量显著增加(P<0.01)。(3)CPT评估持续注意：癫痫组较对照组反应时显著延长(P<0.01),漏报率增加(P<0.05)。(4)双任务实验评估分散注意功能：相比较于对照组,癫痫组双任务比单任务划销方格数目减少,字符串正确率减小,减退程度增加(P<0.01)。(5)ANT测试：癫痫组比对照组执行控制网络效率减低,平均反应时间显著延长(P<0.01),警觉网络、定向网络和错误率与对照组相比较无显著差异。2.各变量间相关分析结果：(1)癫痫组的警觉网络与Stroop错误率干扰量、CPT反应时呈正相关；对照组的警觉网络与Stroop反应时干扰量呈正相关。(2)癫痫组和对照组的定向网络与Stroop反应时干扰量呈正相关。(3)癫痫组的执行控制网络与Stroop反应时干扰量、错误率干扰量和CPT反应时呈正相关,对照组的执行网络与CPT反应时呈正相关。结论：1.蒙特利尔认知功能评估说明癫痫患者的执行、注意和延迟回忆认知有损害,抽象、定向、命名能力、语言功能无明显损害。2. Stroop实验、CPT和双任务实验结果分别提示癫痫患者的选择注意、持续注意和分散注意功能均受损。3.ANT结果提示癫痫患者执行控制网络效率减低,平均时间延长,警觉网络和定向网络与对照组相比无明显差异,说明癫痫患者的执行控制网络功能受损,而警觉网络和定向网络功能保留。4.癫痫患者的警觉网络和执行网络与Stroop实验和CPT指标、定向网络与Stroop实验指标具有良好的相关性,说明警觉网络和执行网络功能与选择注意和持续注意相关,而定向网络和选择注意有一定关系。提示注意网络主要反映选择注意功能,持续注意相对次之,而对分散注意的敏感性相对较差。5.ANT可作为反映癫痫患者的注意功能特别是选择注意功能损害的电生理学指标。今后,将注意功能和注意网络测试相结合,可更加全面地反映癫痫患者注意功能的损害。
Obstract:We study the attentional function and attention networks in patients with epilepsy to explore the characters of the attentional function and attention networks, find the Electrophysiological index of the attentional impairment for epilepsy patients, and analyse the relation of attentional function and attention networks so that we can provide a good fundation for the further study of the attentional function and attention networks in patients with epilepsy. Methods:Selected inpatients and outpatients as a case group of 69 cases. Selected 35 healthy volunteers whose age, sex and average schooling years are similar with the case group as normal control group. None of the volunteers in the control group had neuropathy or mental disorder history. All of the patients had CT or MRI head check. The general cognitive function of the subjects were assessed by Montreal Cognitive Assessment(Moca Beijing version). All the patients and the volunteers did Stroop, Continuous Performance Test(CPT) and dual task to assess their selected attention,sustained attention and divided attention. Collected their reaction time and false rate under incongruous, congruous and neutral conditions in Stroop, and calculated their respective interfered effect; Collected the reaction time, missing response rate and false response rate of CPT; Collected the boxes crossed and right rate of digit strings during single task and dual task and calculated their respective dual task decrement;Meanwhile they did Attention Networks Test (ANT). Calculated each patient's reaction time of orienting, alerting, excutive control network, the average response time and accuracy. Results:1. The comparative analysis of groups:(1)The results of Montreal Cognitive Assessment:epilepsy patients had obvious cognitive disorder in executive, attention and delayed memory(P<0.05), but no cognitive disorder in abstract, orientation, naming and verbalization(P>0.05). (2) Stroop test for access selected attention:the reaction time for epilepsy group prolonged significantly than control group under incongruous condition(P<0.01), error rate increased significantly under incongruous, congruous and neutral conditions(P<0.01). Reaction time interfered effects and error interfered effects increased significantly under incongruous and neutral conditions(P<0.01). (3) CPT for access sustained attention:The reaction time for epilepsy group prolonged significantly than control group(P<0.01), and the omission rate increased(P<0.05). (4) Dual task for divided attention:the boxes crossed and right rate of digit strings decreased and decrement increased during dual task than single task(P<0.01). (5) ANT:the rate of executive control network decreased for epilepsy group than control group and their mean reaction time prolonged significantly(P<0.01).The alerting and orienting network showed no significant difference between epilepsy group and control group.2. The variables related to the results of the analysis:(1) The alerting network has direct correlation to the error interfered effects of Stroop and CPT reaction time in epilepsy group; the alerting network has direct correlation to the time interfered effects of Stroop in control group. (2) The orienting network has direct correlation to the time interfered effects of Stroop in epilepsy group and control group. (3) The executive control network has direct correlation to the time interfered effects, error interfered effects of Stroop and CPT reaction time in epilepsy group; the executive control network has direct correlation to the CPT reaction time in control group. Conclusion:1. The results of Montreal Cognitive Assessment demonstrate that the executive, attention and delayed memory functions of the epilepsy patients decrease, but the abstract, orientation, naming and verbalization functions remain.2. The results of Stroop, CPT and dual task demonstrate that the selected attention, sustained attention and divided attention have all been damaged in epilepsy patients.3. The results of ANT demonstrate that the rate of executive control network decreased and mean reaction time prolonged for epilepsy patients. The alerting and orienting network showed no significant difference. It demonstrate that the executive control network of epilepsy patients has been damaged but the functions of alerting and orienting network remain.4. For epilepsy patients, the alerting and executive control network have good correlation to the index of Stroop and CPT, and the orienting network has good correlation to the index of Stroop. It demonstrate that the alerting and executive control network have correlation to selected attention and sustained attention and the orienting network has correlation to sustained attention. Attention network mainly reflex selected attention, and sustained attention comes the next, and divided attention worse relatively. ANT can be regarded as an electrophysiology index which reflexes the epilepsy patients' attentional function especially the selected attention function. In the future, we can combine the test of attentional function and attention network in order to reflex the impairment of epilepsy patients more roundly.
Obstract:We study the attentional function and attention networks in patients with epilepsy to explore the characters of the attentional function and attention networks, find the Electrophysiological index of the attentional impairment for epilepsy patients, and analyse the relation of attentional function and attention networks so that we can provide a good fundation for the further study of the attentional function and attention networks in patients with epilepsy. Methods:Selected inpatients and outpatients as a case group of 69 cases. Selected 35 healthy volunteers whose age, sex and average schooling years are similar with the case group as normal control group. None of the volunteers in the control group had neuropathy or mental disorder history. All of the patients had CT or MRI head check. The general cognitive function of the subjects were assessed by Montreal Cognitive Assessment(Moca Beijing version). All the patients and the volunteers did Stroop, Continuous Performance Test(CPT) and dual task to assess their selected attention,sustained attention and divided attention. Collected their reaction time and false rate under incongruous, congruous and neutral conditions in Stroop, and calculated their respective interfered effect; Collected the reaction time, missing response rate and false response rate of CPT; Collected the boxes crossed and right rate of digit strings during single task and dual task and calculated their respective dual task decrement;Meanwhile they did Attention Networks Test (ANT). Calculated each patient's reaction time of orienting, alerting, excutive control network, the average response time and accuracy. Results:1. The comparative analysis of groups:(1)The results of Montreal Cognitive Assessment:epilepsy patients had obvious cognitive disorder in executive, attention and delayed memory(P<0.05), but no cognitive disorder in abstract, orientation, naming and verbalization(P>0.05). (2) Stroop test for access selected attention:the reaction time for epilepsy group prolonged significantly than control group under incongruous condition(P<0.01), error rate increased significantly under incongruous, congruous and neutral conditions(P<0.01). Reaction time interfered effects and error interfered effects increased significantly under incongruous and neutral conditions(P<0.01). (3) CPT for access sustained attention:The reaction time for epilepsy group prolonged significantly than control group(P<0.01), and the omission rate increased(P<0.05). (4) Dual task for divided attention:the boxes crossed and right rate of digit strings decreased and decrement increased during dual task than single task(P<0.01). (5) ANT:the rate of executive control network decreased for epilepsy group than control group and their mean reaction time prolonged significantly(P<0.01).The alerting and orienting network showed no significant difference between epilepsy group and control group.2. The variables related to the results of the analysis:(1) The alerting network has direct correlation to the error interfered effects of Stroop and CPT reaction time in epilepsy group; the alerting network has direct correlation to the time interfered effects of Stroop in control group. (2) The orienting network has direct correlation to the time interfered effects of Stroop in epilepsy group and control group. (3) The executive control network has direct correlation to the time interfered effects, error interfered effects of Stroop and CPT reaction time in epilepsy group; the executive control network has direct correlation to the CPT reaction time in control group. Conclusion:1. The results of Montreal Cognitive Assessment demonstrate that the executive, attention and delayed memory functions of the epilepsy patients decrease, but the abstract, orientation, naming and verbalization functions remain.2. The results of Stroop, CPT and dual task demonstrate that the selected attention, sustained attention and divided attention have all been damaged in epilepsy patients.3. The results of ANT demonstrate that the rate of executive control network decreased and mean reaction time prolonged for epilepsy patients. The alerting and orienting network showed no significant difference. It demonstrate that the executive control network of epilepsy patients has been damaged but the functions of alerting and orienting network remain.4. For epilepsy patients, the alerting and executive control network have good correlation to the index of Stroop and CPT, and the orienting network has good correlation to the index of Stroop. It demonstrate that the alerting and executive control network have correlation to selected attention and sustained attention and the orienting network has correlation to sustained attention. Attention network mainly reflex selected attention, and sustained attention comes the next, and divided attention worse relatively. ANT can be regarded as an electrophysiology index which reflexes the epilepsy patients' attentional function especially the selected attention function. In the future, we can combine the test of attentional function and attention network in order to reflex the impairment of epilepsy patients more roundly.
引文
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